Gliederung

Objective

It has been shown that immediately placed ventricular drainage improved prognosis of intraventricular hemorrhage. Our aim was to define predictors of outcome and to investigate whether there is a limit of age, beyond which prognosis of survival and functional outcome becomes unacceptably poor.

Methods

In a retrospective study a homogenous group of 108 adult patients (1996-2002) were all treated with intraventricular drainage after typical intracerebral hemorrhages associated with intraventricular hemorrhage. Univariate and stepwise multivariate regression analysis were performed to evaluate age and CT morphological, initial and postoperative clinical parameters as predictors for survival and functional outcome.

Results

Only 4 out of 70 (6%) patients older than 60 years achieved a GOS of 4 or 5 compared to 12 out of 39 ( 31%) patients younger than 60 years. No patient with an initial GCS score of less than 9 had a favorable outcome. Univariate regression analysis showed significant correlation of hydrocephalus, volume of the associated intracerebral hemorrage, midline shift and ventricular blood distribution (Le Roux score) as CT morphological parameters and initial GCS score to short term (30 days) and long-term survival (6 months) and functional outcome. Age did not correlate to short term, but to long-term survival and GOS. As postoperative parameters ventriculitis and sepsis correlated with GOS whereas pneumonia did not. Multivariate regression analysis proved age, initial GCS, hydrocephalus and volume of the intracerebral hamorrhage as independent variables to predict survival and functional outcome whereas midline shift and Le Roux score did not. Prediction for good(GOS 4 or 5) or poor(GOS 1-3) outcome was 0.91 in this model.

Conclusions

Prognosis of intracerebral hemorhage with associated intraventrikular hemorrhage treated with ventricular drainage can be predicted with high accuracy in multivariate regression analysis. Age above 60 years is associated with unfavorable outcome. These prognostic factors will be evaluated in a prospective protocol.